site.btaDebate Over Bulgaria’s National Health Insurance Fund Budget Highlights Key Contentious Topics

During the second reading of the National Health Insurance Fund (NHIF) budget bill on Wednesday, key contentious topics included whether private hospitals should receive funding from the Fund and the need for more money for treating severely ill children.

Petar Petrov from the Vazrazhdane party pointed out that this year’s budget allocates just over BGN 83 million for the treatment of severely ill children, whereas last year, over BGN 100 million were available for this purpose. "We propose increasing this amount by more than BGN 17 million to round it up to BGN 100 million, with the funds coming from payments to foreign health funds and COVID-19 vaccines," he explained.

His colleague, Dimo Drenchev, argued that the issue with the proposed budget lies in its expenditure structure rather than a lack of sufficient funds. "This budget is nearly BGN 10 billion," he emphasized. "What is missing are any reforms or measures to curb fraudulent hospitalizations." According to him, hospital funding is excessive, and part of it could be redirected toward prevention.

Margarita Mahaeva from Vazrazhdane proposed an amendment to allocate an additional BGN 15 million for biomarker testing to determine targeted therapy for cancer patients under outpatient procedures. "In most countries, targeted therapy is already a standard, whereas we still use outdated methods," she argued.

Vasil Pandov from Continue the Change – Democratic Bulgaria (CC-DB) parliamentary group said that the NHIF budget bill backtracks on all policies related to prevention and prophylaxis. "Nothing is being done to reduce out-of-pocket payments for patients or to improve access to medical care, which contradicts the government's program," he stated. The party had proposed an additional BGN 10 million for primary outpatient care to enable general practitioners to create risk assessment profiles for their patients. The bill also included various oversight measures, such as regulations on public procurement in private hospitals, he added.

His colleague, Bozhidar Bozhanov, argued that the best oversight is public oversight and suggested that patients should receive notifications on their phones about medical services provided to them. Meanwhile, Alexander Simidchiev highlighted that, for unknown reasons, biomarkers are classified as medical devices in the NHIF budget, which could create opportunities for corruption.

Kostadin Kostadinov stated that Vazrazhdane is firmly against private hospitals receiving state funding from the NHIF.

Lachezar Ivanov from the GERB-UDF parliamentary group emphasized that the NHIF is not a state structure but a public one, funded by an 8% mandatory health insurance contribution from working Bulgarian citizens. He argued that, according to the Constitution, private and public hospitals are equal. "When a citizen pays their contributions, they have the right to choose where to receive treatment—whether in a private or public healthcare facility," Ivanov said.

Nadezhda Yordanova from CC-DB commented that any spending of public funds should be preceded by fair competition to prevent non-transparent use of public resources.

"This is your political talking point, your political debate is destructive, and what you propose yields no results," commented Kostadin Angelov, chair of the Health Committee and a GERB-UDF MP.

Andrey Chorbanov from there There Is Such a People (TISP) party remarked that it was amusing to see political roles reversed, with politicians defending positions they opposed just months ago. He asked who had nominated the NHIF director. "How many times have you been in power over the last four years and controlled NHIF funds?" he directed at CC-DB.

TISP’s Floor Leader Toshko Yordanov questioned whether it was CC-DB ministers who had imposed mandatory vaccinations and appointed the NHIF director, only to later decide to withdraw their support. Chorbanov reminded Bozhidar Bozhanov (CC-DB MP) that they were the majority in the previous parliament setting policies, asking why they dan’t implement these changes back then.

Yordan Tsonev from the MRF – New Beginning parliamentary group noted that the sector remains unreformed. He reiterated his party’s long-standing call for the NHIF to be de-monopolized. "The issues we are discussing today stem from the NHIF being the sole provider. If private entities managed patient funds, would they allow the very abuses you are now fighting against—such as overbilling and inefficiencies?" he asked. According to him, it is high time for genuine reform, which involves breaking the NHIF’s monopoly and addressing all the consequences of such a move.

Alexander Simidchiev from CC-DB countered, asking, "Is the Fund really a monopoly? It is a financing institution that purchases services, not one that provides them."